AccountId: 011433970860
ContactId: 983db87a-edc2-47a8-8faa-f1e47afcf9b2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287350 ms
Total Talk Time (AGENT): 84983 ms
Total Talk Time (CUSTOMER): 100287 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/983db87a-edc2-47a8-8faa-f1e47afcf9b2_20250502T18:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider office. And before that, this call is being recorded for quality and training purpose. Is it OK for you, [PII]?
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][POSITIVE] Thanks. I want to check the claim status.
[AGENT][POSITIVE] All right. Happy to check a claim. What's the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, policy number is 02135061.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name, [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, and then what is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the build out?
[CUSTOMER][NEUTRAL] The amount $386 even.
[AGENT][NEUTRAL] OK, so it looks like we, yeah, it looks like we did get a claim for the state of service on [PII].
[CUSTOMER][NEUTRAL] Hello, [PII]. Are you there?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Claim was denied on [PII].
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Denial reason was office visits are not covered under the member policy.
[AGENT][NEUTRAL] And the policy did not provide any benefits for the services incurred.
[CUSTOMER][NEUTRAL] OK. As you told us, our office visits are not covered under that members plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so what, is there any specific service you guys only covered or do you guys will not cover office visit?
[AGENT][NEUTRAL] Where the secondary insurance, this particular plan only covers office treatment. It doesn't cover the office visit fee.
[CUSTOMER][NEUTRAL] OK. So you guys doesn't cover office visit fees.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I put this call on hold for a moment?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, thanks for waiting patiently, sir, on the hold. And I want to know that uh this plan is uh, is this a, is this a limited benefit plan?
[AGENT][NEUTRAL] No, we're their secondary plan. It's a Medlink plan.
[CUSTOMER][NEUTRAL] OK. This is, so you guys only cover office treatment, not the office visit fee, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so thanks. Can you provide me the claim number for this one?
[AGENT][NEUTRAL] 3408794
[CUSTOMER][NEUTRAL] OK, sir. Thanks. Can you fax me the EB for this one?
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][NEUTRAL] Yeah, the fax number is [PII].
[AGENT][NEUTRAL] Attention
[CUSTOMER][NEUTRAL] To my name [PII].
[AGENT][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Give it about 5 minutes and it should be there. Is there anything else I can do for you?
[CUSTOMER][NEUTRAL] No, that's it. You can provide me the call reference number for now.
[AGENT][NEUTRAL] Call references my name with my last initial and then today's date. My name again is [PII], that's [PII], last initial [PII], then today's date.
[CUSTOMER][POSITIVE] OK, sir. Thanks for helping, assisting in the claim. Have a good day. Bye for now.
[AGENT][NEUTRAL] You too. Bye-bye.